From the comment, “The dilemma that always exists for providers is whether treating such patients, and the sudden or later hypogonadism, is feeding into their abuse/dependent personality versus a liberal and nonjudgmental belief that these men need help with their physical symptoms and signs.”

There is no more highly politicized class of drugs than Anabolic Androgenic Steroids (AAS). The nonprescription AAS user is often treated as pariah. Further, there is the problem that almost all physicians are not familiar with nonprescription AAS. The highly politicized topic of AAS halts all medical treatments and results in the unwarranted withholding of effective therapy, already essentially codified in the minds of many.

This rings to mind the attitudes towards infectious disease, “Despite evidence that treatment for drug abuse is effective, many physicians view addicted patients as incurable and morally culpable. As with other `hateful’ patients, physicians may come to view drug users as manipulative, unmotivated, and undeserving of care. . . . Although the physicians’ frustration is understandable, such attitudes contribute to the unwarranted withholding of treatment and to mutually unsatisfactory patient–physician interactions.”

Anabolic Steroid Induced Hypogonadism (ASIH) is a relative frequent cause of male infertility. One of the first problems is the usual negation of patients about steroid abuse
(“I only take it one time…”) and some kind of psychological and/or physical
dependence that difficult the withdrawal. I have seen
patients with a depressive syndrome after androgen cessation in spite of
recovering normal testosterone levels. I think that because of the increasing
frequency of anabolic androgenic steroid users ASIH will be more and more
frequent motive of consultation. It is necessary the implication of
psychiatrists and/or psychologist for an adequate multidisciplinary treatment, as
well as communication campaigns preventing about AAS abuse dangers.

Jason Kovac

An excellent commentary that deserves a read by everyone interested in the topic. Watch for our “rebuttal” in an upcoming issue !

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